Copies of the documents mentioned in this paper can be also be obtained from these addresses.

Summary

The Minister for Health and Community Care has announced the Scottish Executive's intention to:

change the administrative boundaries of NHS Greater Glasgow and NHS Highland to allow them to take over responsibility for managing the delivery of health services in relevant parts of the Argyll and Clyde area;

clear the accumulated financial deficit of NHS Argyll and Clyde; and

consult on what the new administrative boundaries for NHS Greater Glasgow and NHS Highland should be.

The Scottish Executive has not reached any firm view of what these new administrative boundaries should be. We want to know the views of local people and the Minister has stated that his final decision will be informed by the responses to this consultation exercise.

The attached consultation paper seeks your comments on a number of options for redrawing the administrative boundaries of NHS Greater Glasgow and NHS Highland. It does not seek comments on the Minister's decision on the dissolution of NHS Argyll and Clyde. Nor is it a consultation on the organisation of local NHS hospital or community services as these services are not affected by this consultation process.

When this consultation has concluded, the Minister for Health and Community Care will consider the views expressed and the issues raised before coming to a decision on where the new boundaries should be drawn. A further consultation will then take place with NHS staff and their representatives on issues relating to their transfer to NHS Greater Glasgow or NHS Highland.

Local people can be assured that while these consultation processes are underway, the healthcare provision and services they rely on will continue. Ongoing clinical developments, hospital and health centre building programmes and service redesign work will not be delayed by the consultation process.

Part One

REDRAWING NHS BOUNDARIES IN ARGYLL AND CLYDE

What are the reasons for the dissolution of NHS Argyll and Clyde?

1. Over a number of years it has become apparent that the geography and the urban and rural mix of the NHS Argyll and Clyde area did not contribute to its effective management. This is evidenced by the fact that NHS Argyll and Clyde has accumulated a financial overspend which a recent report from the Auditor General predicted might rise as high as £80m to £100m. NHS Argyll and Clyde is the only Board which has accumulated such a significant financial deficit. The Scottish Executive cannot justify allowing a publicly-funded body to spend so much more than its income.

2. The decision to dissolve NHS Argyll and Clyde opens up opportunities in the future for the successor Boards to introduce changes in the way services are delivered. The creation of larger geographical areas for NHS Greater Glasgow and NHS Highland is intended to improve the management, planning and delivery of health services through the removal of bureaucratic boundaries. The Executive's response to the recommendations of the National Framework for Service Change 1 carried out by Professor David Kerr will inform the planning of services in the new Board areas, as in the rest of Scotland.

3. That is why the Minister for Health and Community Care, in a statement to Parliament on 19 May 2005, announced the Scottish Executive's intention to:

place an order before Parliament to change the administrative boundaries of NHS Greater Glasgow and NHS Highland to allow them to take over responsibility for managing the delivery of health services in relevant areas of Argyll and Clyde;

clear the accumulated financial deficit of NHS Argyll and Clyde; and

consult on what the new administrative boundaries for NHS Greater Glasgow and NHS Highland should be.

4. Given the structural problems facing NHS Argyll and Clyde it has been decided not to offer the option of writing off the accumulated deficit while maintaining the current structure. NHS Argyll and Clyde will therefore be dissolved on 31 March 2006.

What is the consultation about?

5. As NHS Argyll and Clyde is to be dissolved on 31 March 2006, the administrative boundaries of NHS Greater Glasgow and NHS Highland must be adjusted on 1 April 2006 to include all of the NHS Argyll and Clyde area. This consultation is therefore about what parts of the current NHS Argyll and Clyde area will in the future be managed by NHS Greater Glasgow and what parts will be managed by NHS Highland.

6. The consultation does not seek comments on the decision on the dissolution of NHS Argyll and Clyde. Also it does not cover the organisation of local NHS hospital or community services as these services will not be affected by this consultation process.

What will the new administrative boundaries be?

7. The Scottish Executive has not reached any firm view of what the new administrative boundaries should be: we want to know the views of local people. The Minister for Health and Community Care has stated that he will consider carefully the responses to this consultation exercise and that his final decision on who will manage the local NHS services will be informed by these responses.

What factors should be taken into account in deciding the new administrative boundaries?

8. Initial discussions with local organisations suggest the new administrative boundaries should take account of a number of factors, these include:

Geography:

NHS Argyll and Clyde's geography and its mix of urban and rural communities was suggested as a factor which made effective management very difficult.

Rurality:

The need to provide effective health services in rural areas and, for example, learn from NHS Highland's knowledge and experience in this area.

Co-terminosity:

The merits of Argyll and Bute Council having a relationship with only one Health Board.

Natural Communities:

The need to recognise the very close links of the Helensburgh and Lomond areas with Glasgow.

Regional Planning: A much greater emphasis will be placed on regional planning, and by joining the urban parts of Argyll and Clyde to the Greater Glasgow conurbation, and the rural areas north of the river to Highland, it will ally geographical areas with Boards that have relevant experience in managing and delivering health care in urban and rural areas.

What are the proposed options for new administrative boundaries?

9. These factors suggest three possible boundary options which can be briefly described as follows:

Option 1

The Argyll and Bute Council area to be included within the administrative boundary of NHS Highland with the remainder of the NHS Argyll and Clyde area included within the administrative boundary of NHS Greater Glasgow.

Option 2

All of the existing Argyll and Bute Council area to go to NHS Highland with the exception of the former Dumbarton District Council area, which includes the west shore of Loch Lomond, Helensburgh, Cardross and the Roseneath Peninsula, with the remainder of the NHS Argyll and Clyde area included within the administrative boundary area of NHS Greater Glasgow.

Option 3

As option 2, but adding to the NHS Greater Glasgow area the Cowal Peninsula, Dunoon and Bute, Mid Argyll, the Kintyre Peninsula and the islands of Islay, Jura and Gigha.

To help you consider these options, maps are included in the Annex which show the NHS Boards' current and proposed administrative boundaries.

Were other options considered?

10. A number of other options were considered and rejected, including:

Option 4: Maintaining the current NHS Argyll and Clyde structure.

As noted in paragraph 4, it has been decided not to offer the option of writing off the accumulated deficit while retaining the existing structure, as this would not address the structural problems that affected NHS Argyll & Clyde.

Option 5: Establishing an NHS Board with the same boundaries as Argyll and Bute Council.

While an Argyll and Bute Community Health Partnership has received a measure of local support, this option was rejected because creating such a relatively small Board was not seen as addressing fully the structural problems encountered by NHS Argyll and Clyde.

Option 6: Including the entire area of NHS Argyll and Clyde within the administrative boundary of NHS Greater Glasgow.

This option was rejected as it was not seen as addressing fully the complexity of managing the mix of rural and urban communities in the Argyll and Clyde area.

Option 7: Including the entire area of NHS Argyll and Clyde within NHS Highland.

This too was rejected as it was not seen as addressing fully the complexity of managing the mix of rural and urban communities in the Argyll and Clyde area.

However, any comments you may have on these possible options would also be welcome.

What difference will the changes make for patients?

11. Redrawing the Boards' administrative boundaries will not affect patients' existing day-to-day access to local and regional health services. A patient's link to their General Practitioner ( GP) will remain unchanged. Access to hospital services will still be decided on the basis of clinical need and treatment provided, wherever practical and safe to do so, as close to home as possible.

12. Local people in the three NHS Board areas can be assured that necessary healthcare provision and the services they rely on will continue. Ongoing clinical developments, hospital and health centre building programmes and service redesign work will not be delayed by this consultation process.

13. The successor Boards will be fully involved in taking forward work on Shaping the Future, the clinical strategy and modernisation framework for Argyll and Clyde. The most recent paper considered by the Board can be found at www.show.scot.nhs.uk/sehd/argyllandclyde. Any proposals to significantly reconfigure services, which have not already been consulted on, would be subject to separate full public consultation and final approval by the Minister for Health and Community Care.

14. The funding to clear the financial deficit will mainly come from Scottish Executive reserves maintained to enable Ministers to respond to genuinely unforeseen or unavoidable contingencies. This will be supplemented from an unallocated under-spend carried forward from 2004/05. No planned patient care initiatives will be cancelled or postponed to do this.

15. Clearing the accumulated deficit will not have an adverse impact on health funding generally in Scotland or in the successor Boards. NHS Argyll and Clyde's funds will be allocated between the successor boards based, in general, on the Arbuthnott formula. The Arbuthnott formula is the national tool used to allocate funding to NHS Boards across Scotland. This formula takes into account a range of factors including age and sex profile of the population, rurality and deprivation.

What difference will the changes make for staff?

16. There will be no immediate impact on staff in terms of their contracts of employment. When this consultation on administrative boundaries has concluded, the Minister for Health and Community Care will consider the views expressed and the issues raised before coming to a decision on where the new boundaries should be drawn. A further consultation will then take place with NHS staff and their representatives on issues relating to their transfer to NHS Greater Glasgow or NHS Highland.

17. It is recognised that this is an uncertain time for staff and the Scottish Executive is committed to working closely with the three Boards to provide all staff with certainty about their future roles and responsibilities as quickly as possible. This work will be taken forward through the Staff Partnership arrangements already in place in NHSScotland. This will ensure that the trade unions and professional organisations that support staff are fully engaged.

What about representation from Argyll and Clyde on the successor Boards?

18. Once the consultation process is complete and the Minister's decision is known, arrangements will be put in place to ensure that the people of the Argyll and Clyde area are appropriately represented on the Boards of successor organisations 2.

What happens next?

19. The Executive will work with local organisations to capture the views of communities across the Board areas and an independent organisation will be contracted to analyse all the responses submitted to this consultation paper.

I want to find out more - what do I do?

20. Information events are being organised to give people the opportunity to receive more information on the proposals. A website has also been set up where you can find out more; ask questions; submit your views; and view responses to the consultation. This can be accessed at www.show.scot.nhs.uk/sehd/argyllandclyde

This consultation, and all other Scottish Executive consultation exercises, can be viewed online on the consultation web pages of the Scottish Executive website at http://www.scotland.gov.uk/consultations. You can telephone Freephone 0800 77 1234 to find out where your nearest public internet access point is.

Will my comments be made public?

22. Copies of all responses received will be made available to the public. The views expressed by respondents may also be quoted or referred to in any future review of responses.

23. If you do not wish your response to be made public, please ensure that you indicate clearly that all or part of your response is to be treated as confidential. Confidentiality will be strictly respected. Confidential responses will still count in any analysis and your views will of course be taken into account in the same way as non-confidential responses.

Then what happens?

24. When the consultation is concluded the responses will be collated and analysed by an independent organisation to enable the Minister for Health and Community Care to come to an informed decision as to where the new boundaries should be drawn. The Minister will also consider all other information available to him and all representations made to him before coming to a final view.

Copies of all responses received will be made available to the public by the Scottish Executive. The views expressed by respondents may also be quoted or referred to in any future review of responses.

If you do not wish your response to be made public, please ensure that you indicate clearly that all or part of your response is to be treated as confidential. Confidentiality will be strictly respected. Confidential response will still count in any analysis and your views will of course be taken into account in the same way as for non-confidential responses.

Handling your response

The Scottish Executive need to know how you wish your response to be handled and, in particular, whether you are happy for your response to be made public. Please provide the information and confidentiality information requested as this will ensure that we treat your response appropriately. If you ask for your response not to be published we will regard it as confidential, and we will treat it accordingly. You should be aware that the Scottish Executive is subject to the provisions of the Freedom of Information (Scotland) Act 2002 and would therefore have to consider any request made to it under the Act for information relating to responses made to this consultation exercise.

What happens next?

Where permission is given for a response to be made public it will be placed in the Scottish Executive Library and on the Scottish Executive Consultation website http://www.scotland.gov.uk/consultations. We will check all responses where agreement to publish has been given for any potentially defamatory material before placing them in the library or on the website. You can make arrangements to view responses by contacting the SE Library on 0131 244 4552. Responses can be copied and sent to you, but a charge may be made for this service.

Following the consultation closing date, all responses will be analysed and considered along with any other available evidence to help the Minister for Health and Community Care reach a decision on the Boards' new administrative boundaries.

A report on the consultation and the Minister's decision will be published on the consultation website ( http://www.scotland.gov.uk/consultations). A summary will also be sent to the address provided by each respondent.